Induction chemotherapy before surgery for early-stage lung cancer: A novel approach

K. M W Pisters, R. J. Ginsberg, D. J. Giroux, J. B. Putnam, M. G. Kris, D. H. Johnson, J. R. Roberts, J. Mault, J. J. Crowley, P. A. Bunn

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231 Scopus citations

Abstract

Objective: This phase H trial assessed the feasibility, as measured by response rate, toxicity, resectability rate, and surgical morbidity and mortality rates, of perioperative paclitaxel and carboplatin chemotherapy in patients with early-stage non-small cell lung carcinoma. Methods: All patients required negative mediastinoscopy results and adequate medical parameters to undergo induction chemotherapy and an operation. Superior sulcus patients were excluded. Chemotherapy consisted of paclitaxel 225 mg/m2 over 3 hours and carboplatin (area under the curve = 6) every 21 days for 2 cycles preoperatively. Three postoperative cycles of chemotherapy were planned for patients undergoing complete resection. Results: Between June 1996 and July 1998, 94 patients were entered into the study. Sixty-five (69%) were men, and the median age was 64 years (range, 34-79 years). After induction chemotherapy, 53 of 94 (56%; 95% confidence interval, 46%-67%) had a major objective response, 88 (94%) underwent surgical exploration, and 81 (86%; 95% confidence interval, 78%-92%) underwent complete resection. Reasons for not undergoing an operation included disease progression (n = 3), clinically unresectable status (n = 1), death (n = 1), and patient lost to follow-up (n = 1). Two postoperative deaths occurred. Six (6%; 95% confidence interval, 0%-13%) pathologic complete responses were observed. Ninety (96%) patients received the planned preoperative chemotherapy versus 45% receiving postoperative chemotherapy. No unexpected chemotherapy or surgical morbidity occurred. The 1-year survival is currently estimated at 85%, and the median survival has not yet been reached. Conclusions: Induction chemotherapy with paclitaxel and carboplatin is feasible and produces a high response rate with acceptable morbidity and mortality rates in early-stage non-small cell lung carcinoma. A prospective randomized trial comparing 3 cycles of induction chemotherapy and surgery with surgery alone in early-stage non-small cell lung carcinoma is planned.

Original languageEnglish (US)
Pages (from-to)429-439
Number of pages11
JournalJournal of Thoracic and Cardiovascular Surgery
Volume119
Issue number3
DOIs
StatePublished - Jan 1 2000

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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    Pisters, K. M. W., Ginsberg, R. J., Giroux, D. J., Putnam, J. B., Kris, M. G., Johnson, D. H., Roberts, J. R., Mault, J., Crowley, J. J., & Bunn, P. A. (2000). Induction chemotherapy before surgery for early-stage lung cancer: A novel approach. Journal of Thoracic and Cardiovascular Surgery, 119(3), 429-439. https://doi.org/10.1016/S0022-5223(00)70120-6